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DISCUSSION
Several questions were posed earlier in this
paper and the results presented above begin to ad-dress
them. Blacks are approximately 40 percent
more likely to die in a given year than whites (after
adjustment for age differences) and this difference
is not due primarily to the lower educational levels
of blacks, on average, as compared to whites. Sub-stantial
racial differences in mortality persist at ev-ery
level of educational attainment. There are sub-stantial
educational differences in mortality within
each race-sex group: persons of the lowest educa-tional
level (0-8 years) are around 50 percent more
likely to die in a given year than persons with some
college education, after adjustment for age differ-ences.
Much larger differences in mortality by both
race and education are observed at the younger age
groups.
This study found an unusual rise in age-ad-justed
mortality for both black males and black fe-males
at 1 2 years ofeducation. There is no reason to
expect that blacks with 1 2 years ofeducation would
have higher mortality than blacks with 0-8 years of
education. Differences in classification of educa-tion
in the death versus the census data could con-tribute
to this finding. If a substantial number of
blacks had completed 12 years of education but did
not attain a high school diploma, then they could be
counted in the " 1
2" category on the death certificate
(numerator) and in the "9-1 1" category in the cen-sus
data (denominator). This would result in the
death rate for 12 years of education being inflated.
Also, a study on the quality of educational data re-ported
on the death certificate found that the num-ber
of decedents with 1 2 years of education (re-ported
by next of kin) markedly exceeded counts
from matched survey data on self-reported educa-tional
level, and concluded that death rates for those
with 12 years of schooling might need downward
adjustment'". This peak in mortality at 12 years of
education was present in every age group for blacks,
but was much more pronounced for both black males
and black females over age 45.
This study suggests that educational differences
between blacks and whites in North Carolina do not
explain the higher mortality rates of blacks. Part of
this finding may be due to the fact that education is
imperfectly correlated with income and occupational
status 113
, which are also important determinants of
mortality. In 1983 the earning capacity of black
college graduates was almost identical to that of
white high school graduates 18
. Information on these
dimensions of socioeconomic status might help
explain the persistent racial differential in mortal-ity,
though there may be problems of interpretation
due to the problem of reverse causation discussed
above. One study has shown substantial errors in
reporting education on the death certificate, prob-ably
resulting in a net over-reporting ofeducational
level 1 ", and so findings of the present study may be
biased due to poor data quality7
.
Several factors could account for the higher
mortality of blacks at each level of education found
in the present study. Other studies have found unex-plained
racial differences in health after controlling
for income and other known risk factors3 - 12
. Health
care access may be more limited for blacks, due in
part to shortages of health care providers in black
communities. At the same educational level as
whites, blacks may have different occupational char-acteristics
which could be associated increased
worksite risks and with less adequate health insur-ance
coverage, affecting access to health care. Sev-eral
authors have suggested that racism and racial
discrimination may be a factor in higher black mor-tality
in the United States'
61819-20 -21 -2223
. This could,
for example, contribute to limited job opportunities
for blacks, lead to restricted access to the health care
system for blacks24
, or result in blacks being treated
differently by medical care providers25 -26 27
. Barriers
associated with minority status could also produce
higher levels of stress resulting in increased hyper-tension
13 -28-29 and negative health behaviors such as
smoking30
, alcohol abuse, or violence.

DISCUSSION
Several questions were posed earlier in this
paper and the results presented above begin to ad-dress
them. Blacks are approximately 40 percent
more likely to die in a given year than whites (after
adjustment for age differences) and this difference
is not due primarily to the lower educational levels
of blacks, on average, as compared to whites. Sub-stantial
racial differences in mortality persist at ev-ery
level of educational attainment. There are sub-stantial
educational differences in mortality within
each race-sex group: persons of the lowest educa-tional
level (0-8 years) are around 50 percent more
likely to die in a given year than persons with some
college education, after adjustment for age differ-ences.
Much larger differences in mortality by both
race and education are observed at the younger age
groups.
This study found an unusual rise in age-ad-justed
mortality for both black males and black fe-males
at 1 2 years ofeducation. There is no reason to
expect that blacks with 1 2 years ofeducation would
have higher mortality than blacks with 0-8 years of
education. Differences in classification of educa-tion
in the death versus the census data could con-tribute
to this finding. If a substantial number of
blacks had completed 12 years of education but did
not attain a high school diploma, then they could be
counted in the " 1
2" category on the death certificate
(numerator) and in the "9-1 1" category in the cen-sus
data (denominator). This would result in the
death rate for 12 years of education being inflated.
Also, a study on the quality of educational data re-ported
on the death certificate found that the num-ber
of decedents with 1 2 years of education (re-ported
by next of kin) markedly exceeded counts
from matched survey data on self-reported educa-tional
level, and concluded that death rates for those
with 12 years of schooling might need downward
adjustment'". This peak in mortality at 12 years of
education was present in every age group for blacks,
but was much more pronounced for both black males
and black females over age 45.
This study suggests that educational differences
between blacks and whites in North Carolina do not
explain the higher mortality rates of blacks. Part of
this finding may be due to the fact that education is
imperfectly correlated with income and occupational
status 113
, which are also important determinants of
mortality. In 1983 the earning capacity of black
college graduates was almost identical to that of
white high school graduates 18
. Information on these
dimensions of socioeconomic status might help
explain the persistent racial differential in mortal-ity,
though there may be problems of interpretation
due to the problem of reverse causation discussed
above. One study has shown substantial errors in
reporting education on the death certificate, prob-ably
resulting in a net over-reporting ofeducational
level 1 ", and so findings of the present study may be
biased due to poor data quality7
.
Several factors could account for the higher
mortality of blacks at each level of education found
in the present study. Other studies have found unex-plained
racial differences in health after controlling
for income and other known risk factors3 - 12
. Health
care access may be more limited for blacks, due in
part to shortages of health care providers in black
communities. At the same educational level as
whites, blacks may have different occupational char-acteristics
which could be associated increased
worksite risks and with less adequate health insur-ance
coverage, affecting access to health care. Sev-eral
authors have suggested that racism and racial
discrimination may be a factor in higher black mor-tality
in the United States'
61819-20 -21 -2223
. This could,
for example, contribute to limited job opportunities
for blacks, lead to restricted access to the health care
system for blacks24
, or result in blacks being treated
differently by medical care providers25 -26 27
. Barriers
associated with minority status could also produce
higher levels of stress resulting in increased hyper-tension
13 -28-29 and negative health behaviors such as
smoking30
, alcohol abuse, or violence.